Skip to main content
SpringerLink
Log in

Nonoperative Management Options for Symptomatic Cartilage Lesions

  • Chapter
  • First Online:
Cartilage Injury of the Knee

  • 2232 Accesses

Abstract

This chapter describes chronic and acute chondral damage. Clinical history, etiology, and associated pathologies are discussed. Indications and contraindications for nonoperative management are reviewed. Nonoperative management is discussed in detail and operative treatment is described briefly, highlighting the most up-to-date level one evidence. Treatment algorithms are provided with a focus on nonoperative techniques. Outcomes are discussed. Future directions are presented and the author’s algorithm is presented. This chapter is based on the framework of chondroprotection, chondrofacilitation, and resurfacing.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Murray IR, Corselli M, Petrigliano FA, Soo C, Peault B. Recent insights into the identity of mesenchymal stem cells: Implications for orthopaedic applications. Bone Joint J. 2014;96-B(3):291–8.

    Article  CAS  PubMed  Google Scholar 

  2. Dominici M, Le Blanc K, Mueller I, Slaper-Cortenbach I, Marini F, Krause D, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International Society for Cellular Therapy position statement. Cytotherapy. 2006;8(4):315–7.

    Article  CAS  PubMed  Google Scholar 

  3. Flanigan DC, Harris JD, Trinh TQ, Siston RA, Brophy RH. Prevalence of chondral defects in athletes’ knees: a systematic review. Med Sci Sport Exerc. 2010;42(10):1795–801.

    Article  Google Scholar 

  4. Brophy RH, Zeltser D, Wright RW, Flanigan D. Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment. Arthroscopy. 2010;26(1):112–20.

    Article  PubMed  Google Scholar 

  5. Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee. 2007;14(3):177–82.

    Article  CAS  PubMed  Google Scholar 

  6. Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456–60.

    Article  CAS  PubMed  Google Scholar 

  7. Zaffagnini S, Vannini F, Di Martino A, Andriolo L, Sessa A, Perdisa F, et al. Low rate of return to pre-injury sport level in athletes after cartilage surgery: a 10-year follow-up study. Knee Surg Sport Traumatol Arthrosc. 2019;27(8):2502–10.

    Article  CAS  Google Scholar 

  8. Walczak BE, McCulloch PC, Kang RW, Zelazny A, Tedeschi F, Cole BJ. Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players. J Knee Surg. 2008;21(1):27–33.

    Article  PubMed  Google Scholar 

  9. Roos H, Lindberg H, Gärdsell P, Lohmander LS, Wingstrand H. The prevalence of gonarthrosis and its relation to meniscectomy in former soccer players. Am J Sports Med. 1994;22(2):219–22.

    Article  CAS  PubMed  Google Scholar 

  10. Messner K, Maletius W. The long-term prognosis for severe damage to weight-bearing cartilage in the knee: a 14-year clinical and radiographic follow-up in 28 young athletes. Acta Orthop Scand. 1996;67(2):165–8.

    Article  CAS  PubMed  Google Scholar 

  11. Brophy RH, Rodeo SA, Barnes RP, Powell JW, Warren RF. Knee articular cartilage injuries in the National Football League: epidemiology and treatment approach by team physicians. J Knee Surg. 2009;22(4):331–8.

    Article  PubMed  Google Scholar 

  12. Murray IR, Benke MT, Mandelbaum BR. Management of knee articular cartilage injuries in athletes: chondroprotection, chondrofacilitation, and resurfacing. Knee Surg Sport Traumatol Arthrosc. 2016;24(5):1617–26.

    Article  Google Scholar 

  13. Berger MJ, McKenzie CA, Chess DG, Goela A, Doherty TJ. Quadriceps neuromuscular function and self-reported functional ability in knee osteoarthritis. J Appl Physiol. 2012;113(2):255–62.

    Article  CAS  PubMed  Google Scholar 

  14. Chang A, Hayes K, Dunlop D, Song J, Hurwitz D, Cahue S, et al. Hip abduction moment and protection against medial tibiofemoral osteoarthritis progression. Arthritis Rheum. 2005;52(11):3515–9.

    Article  PubMed  Google Scholar 

  15. Fransen M, McConnell S. Land-based exercise for osteoarthritis of the knee: a metaanalysis of randomized controlled trials. J Rheumatol. 2009;36(6):1109–17.

    Article  PubMed  Google Scholar 

  16. Segal NA, Glass NA, Torner J, Yang M, Felson DT, Sharma L, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthr Cartil. 2010;18(6):769–75.

    Article  CAS  Google Scholar 

  17. Aaboe J, Bliddal H, Messier SP, Alkjaer T, Henriksen M. Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis. Osteoarthr Cartil. 2011;19(7):822–8.

    Article  CAS  Google Scholar 

  18. Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol 2020;72(2):220–233.

    Google Scholar 

  19. Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, et al. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthr Cartil. 2019;27(11):1578–89.

    Article  CAS  Google Scholar 

  20. Deyle GD, Allen CS, Allison SC, Gill NW, Hando BR, Petersen EJ, et al. Physical therapy versus glucocorticoid injection for osteoarthritis of the knee. N Engl J Med. 2020;382(15):1420–9.

    Article  CAS  PubMed  Google Scholar 

  21. Bartholdy C, Klokker L, Bandak E, Bliddal H, Henriksen M. A standardized “rescue” exercise program for symptomatic flare-up of knee osteoarthritis: description and safety considerations. J Orthop Sport Phys Ther. 2016;46(11):942–6.

    Article  Google Scholar 

  22. Lee K-H, Lim J-W, Park Y-G, Ha Y-C. Erratum to: vitamin D deficiency is highly concomitant but not strong risk factor for mortality in patients aged 50 year and older with hip fracture. J Bone Metabol Korea (South). 2016;23:49.

    Google Scholar 

  23. Bricca A, Juhl CB, Steultjens M, Wirth W, Roos EM. Impact of exercise on articular cartilage in people at risk of, or with established, knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med. 2019;53(15):940–7.

    Article  PubMed  Google Scholar 

  24. Shorter E, Sannicandro AJ, Poulet B, Goljanek-Whysall K. Skeletal muscle wasting and its relationship with osteoarthritis: a mini-review of mechanisms and current interventions. Curr Rheumatol Rep. 2019;21(8):40.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ferraz RB, Gualano B, Rodrigues R, Kurimori CO, Fuller R, Lima FR, et al. Benefits of resistance training with blood flow restriction in knee osteoarthritis. Med Sci Sport Exerc. 2018;50(5):897–905.

    Article  Google Scholar 

  26. Minniti MC, Statkevich AP, Kelly RL, Rigsby VP, Exline MM, Rhon DI, et al. The safety of blood flow restriction training as a therapeutic intervention for patients with musculoskeletal disorders: a systematic review. Am J Sport Med. 2019;363546519882652

    Google Scholar 

  27. Duivenvoorden T, Brouwer RW, van Raaij TM, Verhagen AP, Verhaar JA, Bierma-Zeinstra SM. Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database Syst Rev. 2015;3:CD004020.

    Google Scholar 

  28. Azuma K, Osaki T, Tsuka T, Imagawa T, Okamoto Y, Takamori Y, et al. Effects of oral glucosamine hydrochloride administration on plasma free amino acid concentrations in dogs. Mar Drugs. 2011;9(5):712–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Imagawa K, de Andres MC, Hashimoto K, Pitt D, Itoi E, Goldring MB, et al. The epigenetic effect of glucosamine and a nuclear factor-kappa B (NF-kB) inhibitor on primary human chondrocytes--implications for osteoarthritis. Biochem Biophys Res Commun. 2011;405(3):362–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Dalirfardouei R, Karimi G, Jamialahmadi K. Molecular mechanisms and biomedical applications of glucosamine as a potential multifunctional therapeutic agent. Life Sci. 2016;152:21–9.

    Article  CAS  PubMed  Google Scholar 

  31. Hui JH, Chan SW, Li J, Goh JC, Li L, Ren XF, et al. Intra-articular delivery of chondroitin sulfate for the treatment of joint defects in rabbit model. J Mol Histol. 2007;38(5):483–9.

    Article  CAS  PubMed  Google Scholar 

  32. Monfort J, Pelletier JP, Garcia-Giralt N, Martel-Pelletier J. Biochemical basis of the effect of chondroitin sulphate on osteoarthritis articular tissues. Ann Rheum Dis. 2008;67(6):735–40.

    Article  CAS  PubMed  Google Scholar 

  33. Ronca F, Palmieri L, Panicucci P, Ronca G. Anti-inflammatory activity of chondroitin sulfate. Osteoarthr Cartil. 1998;6(Suppl A):14–21.

    Article  Google Scholar 

  34. Simental-Mendia M, Sanchez-Garcia A, Vilchez-Cavazos F, Acosta-Olivo CA, Pena-Martinez VM, Simental-Mendia LE. Effect of glucosamine and chondroitin sulfate in symptomatic knee osteoarthritis: a systematic review and meta-analysis of randomized placebo-controlled trials. Rheumatol Int. 2018;38(8):1413–28.

    Article  CAS  PubMed  Google Scholar 

  35. Kahan A, Uebelhart D, De Vathaire F, Delmas PD, Reginster JY. Long-term effects of chondroitins 4 and 6 sulfate on knee osteoarthritis: the study on osteoarthritis progression prevention, a two-year, randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2009;60(2):524–33.

    Article  CAS  PubMed  Google Scholar 

  36. Hochberg MC, Zhan M, Langenberg P. The rate of decline of joint space width in patients with osteoarthritis of the knee: a systematic review and meta-analysis of randomized placebo-controlled trials of chondroitin sulfate. Curr Med Res Opin. 2008;24(11):3029–35.

    Article  CAS  PubMed  Google Scholar 

  37. Nicoliche T, Maldonado DC, Faber J, Silva M. Evaluation of the articular cartilage in the knees of rats with induced arthritis treated with curcumin. PLoS One. 2020;15(3):e0230228.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Zhang Z, Leong DJ, Xu L, He Z, Wang A, Navati M, et al. Curcumin slows osteoarthritis progression and relieves osteoarthritis-associated pain symptoms in a post-traumatic osteoarthritis mouse model. Arthritis Res Ther. 2016;18(1):128.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Shep D, Khanwelkar C, Gade P, Karad S. Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials. 2019;20(1):214.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Xu X, Li X, Liang Y, Ou Y, Huang J, Xiong J, et al. Estrogen modulates cartilage and subchondral bone remodeling in an ovariectomized rat model of postmenopausal osteoarthritis. Med Sci Monit. 2019;25:3146–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Xu K, Sha Y, Wang S, Chi Q, Liu Y, Wang C, et al. Effects of Bakuchiol on chondrocyte proliferation via the PI3K-Akt and ERK1/2 pathways mediated by the estrogen receptor for promotion of the regeneration of knee articular cartilage defects. Cell Prolif. 2019;52(5):e12666.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Lou C, Xiang G, Weng Q, Chen Z, Chen D, Wang Q, et al. Menopause is associated with articular cartilage degeneration: a clinical study of knee joint in 860 women. Menopause. 2016;23(11):1239–46.

    Article  PubMed  Google Scholar 

  43. Son YO, Park S, Kwak JS, Won Y, Choi WS, Rhee J, et al. Estrogen-related receptor gamma causes osteoarthritis by upregulating extracellular matrix-degrading enzymes. Nat Commun. 2017;8(1):2133.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Liang Y, Duan L, Xiong J, Zhu W, Liu Q, Wang D, et al. E2 regulates MMP-13 via targeting miR-140 in IL-1beta-induced extracellular matrix degradation in human chondrocytes. Arthritis Res Ther. 2016;18(1):105.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Arroll B, Goodyear-Smith F. Corticosteroid injections for osteoarthritis of the knee: meta-analysis. BMJ. 2004;328(7444):869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: a randomized clinical trial. JAMA. 2017;317(19):1967–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Raynauld J-P, Buckland-Wright C, Ward R, Choquette D, Haraoui B, Martel-Pelletier J, et al. Safety and efficacy of long-term intraarticular steroid injections in osteoarthritis of the knee: a randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2003;48(2):370–7.

    Article  CAS  PubMed  Google Scholar 

  48. Klocke R, Levasseur K, Kitas GD, Smith JP, Hirsch G. Cartilage turnover and intra-articular corticosteroid injections in knee osteoarthritis. Rheumatol Int. 2018;38(3):455–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Adams ME, Lussier AJ, Peyron JG. A risk-benefit assessment of injections of hyaluronan and its derivatives in the treatment of osteoarthritis of the knee. Drug Saf. 2000;23(2):115–30.

    Article  CAS  PubMed  Google Scholar 

  50. Altman R, Lim S, Steen RG, Dasa V. Hyaluronic acid injections are associated with delay of total knee replacement surgery in patients with knee osteoarthritis: evidence from a large U.S. Health Claims Database. PLoS One. 2015;10(12):e0145776.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  51. Pashuck TD, Kuroki K, Cook CR, Stoker AM, Cook JL. Hyaluronic acid versus saline intra-articular injections for amelioration of chronic knee osteoarthritis: a canine model. J Orthop Res. 2016;34(10):1772–9.

    Article  CAS  PubMed  Google Scholar 

  52. Barreto RB, Sadigursky D, de Rezende MU, Hernandez AJ. Effect of hyaluronic acid on chondrocyte apoptosis. Acta Ortop Bras. 2015;23(2):90–3.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Petterson SC, Plancher KD. Single intra-articular injection of lightly cross-linked hyaluronic acid reduces knee pain in symptomatic knee osteoarthritis: a multicenter, double-blind, randomized, placebo-controlled trial. Knee Surg Sport Traumatol Arthrosc. 2019;27(6):1992–2002.

    Article  Google Scholar 

  54. Petrella RJ, Petrella M. A prospective, randomized, double-blind, placebo controlled study to evaluate the efficacy of intraarticular hyaluronic acid for osteoarthritis of the knee. J Rheumatol. 2006;33(5):951–6.

    CAS  PubMed  Google Scholar 

  55. Pham T, Le Henanff A, Ravaud P, Dieppe P, Paolozzi L, Dougados M. Evaluation of the symptomatic and structural efficacy of a new hyaluronic acid compound, NRD101, in comparison with diacerein and placebo in a 1 year randomised controlled study in symptomatic knee osteoarthritis. Ann Rheum Dis. 2004;63(12):1611–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Listrat V, Ayral X, Patarnello F, Bonvarlet JP, Simonnet J, Amor B, et al. Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee. Osteoarthr Cartil. 1997;5(3):153–60.

    Article  CAS  Google Scholar 

  57. Wang Y, Hall S, Hanna F, Wluka AE, Grant G, Marks P, et al. Effects of Hylan G-F 20 supplementation on cartilage preservation detected by magnetic resonance imaging in osteoarthritis of the knee: a two-year single-blind clinical trial. BMC Musculoskelet Disord. 2011;12:195.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Dasa V, Lim S, Heeckt P. Real-world evidence for safety and effectiveness of repeated courses of hyaluronic acid injections on the time to knee replacement surgery. Am J Orthop (Belle Mead NJ). 2018:47(7).

    Google Scholar 

  59. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259–72.

    Article  PubMed  Google Scholar 

  60. Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy - future or trend? Arthritis Res Ther. 2012;14(4):219.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Rughetti A, Giusti I, D’Ascenzo S, Leocata P, Carta G, Pavan A, et al. Platelet gel-released supernatant modulates the angiogenic capability of human endothelial cells. Blood Transfus. 2008;6(1):12–7.

    PubMed  PubMed Central  Google Scholar 

  62. Liu J, Song W, Yuan T, Xu Z, Jia W, Zhang C. A comparison between platelet-rich plasma (PRP) and hyaluronate acid on the healing of cartilage defects. PLoS One. 2014;9(5):e97293.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  63. Milano G, Deriu L, Sanna Passino E, Masala G, Saccomanno MF, Postacchini R, et al. The effect of autologous conditioned plasma on the treatment of focal chondral defects of the knee. An experimental study. Int J Immunopathol Pharmacol. 2011;24(1 Suppl 2):117–24.

    Article  CAS  PubMed  Google Scholar 

  64. Goodrich LR, Chen AC, Werpy NM, Williams AA, Kisiday JD, Su AW, et al. Addition of mesenchymal stem cells to autologous platelet-enhanced fibrin scaffolds in chondral defects: does it enhance repair? J Bone Joint Surg Am. 2016;98(1):23–34.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Iio K, Furukawa K-I, Tsuda E, Yamamoto Y, Maeda S, Naraoka T, et al. Hyaluronic acid induces the release of growth factors from platelet-rich plasma. Asia-Pacific J Sport Med Arthrosc Rehabil Technol. 2016;4:27–32.

    Google Scholar 

  66. Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, et al. Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc North Am Int Arthrosc Assoc. 2011;27(11):1490–501.

    Article  Google Scholar 

  67. Sanchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, et al. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy. 2012;28(8):1070–8.

    Article  PubMed  Google Scholar 

  68. Filardo G, Kon E, Di Martino A, Di Matteo B, Merli ML, Cenacchi A, et al. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 2012;13:229.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, et al. Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med. 2015;43(7):1575–82.

    Article  PubMed  Google Scholar 

  70. Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med. 2016;44(3):792–800.

    Article  PubMed  Google Scholar 

  71. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41(2):356–64.

    Article  PubMed  Google Scholar 

  72. Cerza F, Carni S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, et al. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40(12):2822–7.

    Article  PubMed  Google Scholar 

  73. Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma. Am J Sports Med. 2017;45(2):339–46.

    Article  PubMed  Google Scholar 

  74. Everhart JS, Cavendish PA, Eikenberry A, Magnussen RA, Kaeding CC, Flanigan DC. Platelet-rich plasma reduces failure risk for isolated meniscal repairs but provides no benefit for meniscal repairs with anterior cruciate ligament reconstruction. Am J Sports Med. 2019;47(8):1789–96.

    Article  PubMed  Google Scholar 

  75. Gobbi A, Chaurasia S, Karnatzikos G, Nakamura N. Matrix-induced autologous chondrocyte implantation versus multipotent stem cells for the treatment of large patellofemoral chondral lesions: a nonrandomized prospective trial. Cartilage. 2015;6(2):82–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  76. Gobbi A, Whyte GP. One-stage cartilage repair using a hyaluronic acid-based scaffold with activated bone marrow-derived mesenchymal stem cells compared with microfracture: five-year follow-up. Am J Sports Med. 2016;44(11):2846–54.

    Article  PubMed  Google Scholar 

  77. Enea D, Cecconi S, Calcagno S, Busilacchi A, Manzotti S, Gigante A. One-step cartilage repair in the knee: collagen-covered microfracture and autologous bone marrow concentrate. A pilot study. Knee. 2015;22(1):30–5.

    Article  CAS  PubMed  Google Scholar 

  78. Krych AJ, Nawabi DH, Farshad-Amacker NA, Jones KJ, Maak TG, Potter HG, et al. Bone marrow concentrate improves early cartilage phase maturation of a scaffold plug in the knee: a comparative magnetic resonance imaging analysis to platelet-rich plasma and control. Am J Sports Med. 2016;44(1):91–8.

    Article  PubMed  Google Scholar 

  79. Krych AJ, Pareek A, King AH, Johnson NR, Stuart MJ, Williams RJ 3rd. Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2017;25(10):3186–96.

    Article  PubMed  Google Scholar 

  80. Skowronski J, Skowronski R, Rutka M. Large cartilage lesions of the knee treated with bone marrow concentrate and collagen membrane--results. Ortop Traumatol Rehabil. 2013;15(1):69–76.

    PubMed  Google Scholar 

  81. Skowronski J, Rutka M. Osteochondral lesions of the knee reconstructed with mesenchymal stem cells - results. Ortop Traumatol Rehabil. 2013;15(3):195–204.

    Article  PubMed  Google Scholar 

  82. Fortier LA, Potter HG, Rickey EJ, Schnabel LV, Foo LF, Chong LR, et al. Concentrated bone marrow aspirate improves full-thickness cartilage repair compared with microfracture in the equine model. J Bone Joint Surg Am. 2010;92(10):1927–37.

    Article  PubMed  Google Scholar 

  83. Potten CS, Loeffler M. Stem cells: attributes, cycles, spirals, pitfalls and uncertainties. Lessons for and from the crypt. Development. 1990;110(4):1001–20.

    Article  CAS  PubMed  Google Scholar 

  84. Chang Y-H, Liu H-W, Wu K-C, Ding D-C. Mesenchymal stem cells and their clinical applications in osteoarthritis. Cell Transplant. 2016;25(5):937–50.

    Article  PubMed  Google Scholar 

  85. Ruetze M, Richter W. Adipose-derived stromal cells for osteoarticular repair: trophic function versus stem cell activity. Expert Rev Mol Med. 2014;16:e9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Wu L, Cai X, Zhang S, Karperien M, Lin Y. Regeneration of articular cartilage by adipose tissue derived mesenchymal stem cells: perspectives from stem cell biology and molecular medicine. J Cell Physiol. 2013;228(5):938–44.

    Article  CAS  PubMed  Google Scholar 

  87. Jang K-M, Lee J-H, Park CM, Song H-R, Wang JH. Xenotransplantation of human mesenchymal stem cells for repair of osteochondral defects in rabbits using osteochondral biphasic composite constructs. Knee Surg Sports Traumatol Arthrosc. 2014;22(6):1434–44.

    Article  PubMed  Google Scholar 

  88. Jung M, Kaszap B, Redohl A, Steck E, Breusch S, Richter W, et al. Enhanced early tissue regeneration after matrix-assisted autologous mesenchymal stem cell transplantation in full thickness chondral defects in a minipig model. Cell Transplant. 2009;18(8):923–32.

    Article  PubMed  Google Scholar 

  89. Nam HY, Karunanithi P, Loo WC, Naveen S, Chen H, Hussin P, et al. The effects of staged intra-articular injection of cultured autologous mesenchymal stromal cells on the repair of damaged cartilage: a pilot study in caprine model. Arthritis Res Ther. 2013;15(5):R129.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  90. Chahla J, Piuzzi NS, Mitchell JJ, Dean CS, Pascual-Garrido C, LaPrade RF, et al. Intra-articular cellular therapy for osteoarthritis and focal cartilage defects of the knee: a systematic review of the literature and study quality analysis. J Bone Joint Surg Am. 2016;98(18):1511–21.

    Article  PubMed  Google Scholar 

  91. Campbell TM, Churchman SM, Gomez A, McGonagle D, Conaghan PG, Ponchel F, et al. Mesenchymal stem cell alterations in bone marrow lesions in patients with hip osteoarthritis. Arthritis Rheumatol (Hoboken, NJ). 2016;68(7):1648–59.

    Article  CAS  Google Scholar 

  92. Cox LGE, van Donkelaar CC, van Rietbergen B, Emans PJ, Ito K. Alterations to the subchondral bone architecture during osteoarthritis: bone adaptation vs endochondral bone formation. Osteoarthr Cartil. 2013;21(2):331–8.

    Article  CAS  Google Scholar 

  93. Suri S, Walsh DA. Osteochondral alterations in osteoarthritis. Bone. 2012;51(2):204–11.

    Article  PubMed  Google Scholar 

  94. Klement MR, Sharkey PF. The significance of osteoarthritis-associated bone marrow lesions in the knee. J Am Acad Orthop Surg. 2019;27(20):752–9.

    Article  PubMed  Google Scholar 

  95. Pelletier J-P, Roubille C, Raynauld J-P, Abram F, Dorais M, Delorme P, et al. Disease-modifying effect of strontium ranelate in a subset of patients from the phase III knee osteoarthritis study SEKOIA using quantitative MRI: reduction in bone marrow lesions protects against cartilage loss. Ann Rheum Dis. 2015;74(2):422–9.

    Article  CAS  PubMed  Google Scholar 

  96. Varenna M, Zucchi F, Failoni S, Becciolini A, Berruto M. Intravenous neridronate in the treatment of acute painful knee osteoarthritis: a randomized controlled study. Rheumatology (Oxford). 2015;54(10):1826–32.

    Article  CAS  Google Scholar 

  97. Laslett LL, Doré DA, Quinn SJ, Boon P, Ryan E, Winzenberg TM, et al. Zoledronic acid reduces knee pain and bone marrow lesions over 1 year: a randomised controlled trial. Ann Rheum Dis. 2012;71(8):1322–8.

    Article  CAS  PubMed  Google Scholar 

  98. Jäger M, Tillmann FP, Thornhill TS, Mahmoudi M, Blondin D, Hetzel GR, et al. Rationale for prostaglandin I2 in bone marrow oedema--from theory to application. Arthritis Res Ther. 2008;10(5):R120.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  99. Mayerhoefer ME, Kramer J, Breitenseher MJ, Norden C, Vakil-Adli A, Hofmann S, et al. Short-term outcome of painful bone marrow oedema of the knee following oral treatment with iloprost or tramadol: results of an exploratory phase II study of 41 patients. Rheumatology (Oxford). 2007;46(9):1460–5.

    Article  CAS  Google Scholar 

  100. Callaghan MJ, Parkes MJ, Hutchinson CE, Gait AD, Forsythe LM, Marjanovic EJ, et al. A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions. Ann Rheum Dis. 2015;74(6):1164–70.

    Article  CAS  PubMed  Google Scholar 

  101. Su K, Bai Y, Wang J, Zhang H, Liu H, Ma S. Comparison of hyaluronic acid and PRP intra-articular injection with combined intra-articular and intraosseous PRP injections to treat patients with knee osteoarthritis. Clin Rheumatol. 2018;37(5):1341–50.

    Article  PubMed  Google Scholar 

  102. Sánchez M, Delgado D, Pompei O, Pérez JC, Sánchez P, Garate A, et al. Treating severe knee osteoarthritis with combination of intra-osseous and intra-articular infiltrations of platelet-rich plasma: an observational study. Cartilage. 2019;10(2):245–53.

    Article  PubMed  Google Scholar 

  103. Deshmukh V, Hu H, Barroga C, Bossard C, Kc S, Dellamary L, et al. A small-molecule inhibitor of the Wnt pathway (SM04690) as a potential disease modifying agent for the treatment of osteoarthritis of the knee. Osteoarthr Cartil. 2018;26(1):18–27.

    Article  CAS  Google Scholar 

  104. Yazici Y, McAlindon TE, Fleischmann R, Gibofsky A, Lane NE, Kivitz AJ, et al. A novel Wnt pathway inhibitor, SM04690, for the treatment of moderate to severe osteoarthritis of the knee: results of a 24-week, randomized, controlled, phase 1 study. Osteoarthr Cartil. 2017;25(10):1598–606.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Kerlan-Jobe Institute, Los Angeles, CA, USA

    Mathew J. Hamula, Abigail L. Campbell & Bert R. Mandelbaum

Authors
  1. Mathew J. Hamula
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Abigail L. Campbell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bert R. Mandelbaum
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bert R. Mandelbaum .

Editor information

Editors and Affiliations

  1. Orthopaedic Surgery and Sports Medicine, Mayo Clinic, Rochester, MN, USA

    Aaron J. Krych

  2. University of Manchester, Manchester, UK

    Leela C. Biant

  3. Orthopedic Sugery, Hospital for Special Surgery, New York, USA

    Andreas H. Gomoll

  4. FIFA Medical Centre of Excellence, Clinica do Dragao, Espregueira-Mendes Sports Centre,, PORTO, Portugal

    João Espregueira-Mendes

  5. O.A.S.I. Bioresearch Foundation, Gobbi N.P.O., Milan, Italy

    Alberto Gobbi

  6. Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan

    Norimasa Nakamura

Rights and permissions

Reprints and permissions

Copyright information

© 2021 ISAKOS

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hamula, M.J., Campbell, A.L., Mandelbaum, B.R. (2021). Nonoperative Management Options for Symptomatic Cartilage Lesions. In: Krych, A.J., Biant, L.C., Gomoll, A.H., Espregueira-Mendes, J., Gobbi, A., Nakamura, N. (eds) Cartilage Injury of the Knee. Springer, Cham. https://doi.org/10.1007/978-3-030-78051-7_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-78051-7_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78050-0

  • Online ISBN: 978-3-030-78051-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation